Nutritional problems in the African region.

Energy-calorie malnutrition (ECM) is the commonest nutritional problem in developing countries in Africa: 0.5-5% of the population under 6 years of age suffer from the severe forms and 4-40% from the moderate forms. It is possible that as many as two-thirds of the preschool children in developing countries in Africa suffer from some EPM (protein-calorie malnutrition). The recent Sahelian drought and civil wars in some countries in Africa have increased the size of the problem and the severity and prevalence of EPM in several parts of Africa. The aetiological factors of EPM in Africa include shortage of calories and protein, as well as increasing and recent tendency to abandon too early breast feeding, sensory deprivation, psychological and emotional trauma, ignorance, superstition and cultural taboos. The evidence available at the moment does not clearly indicate that effects of EPM on learning and behaviour are permanent, although the functions of the brain in the acutely malnourished child are defective. Malnutrition impairs immunological capability and surveillance, and hence augments the mortality and morbidity of infections such as measles especially by impairing cell-mediated immunity and, to a lesser extent, synthesis of immunoglobulins. Endemic goitre (prevalence varies from 2 to 90% in various age groups) in several parts of Africa is due to either iodine deficiency (Ethiopia) or to the goitrogenic effect of cassava diet (Zaire and Nigeria). Deficiencies of vitamins A, B complex and D have been reported in several parts of Africa, albeit sporadically. Dietary intoxications include: a) aflatoxins which may be important in the pathogenesis of hepatic carcinoma, one of the commonest neoplasms in developing countries in Africa; b) chronic cyanide intoxication from cassava (manihot) food derivatives, which on circumstancial evidence seems to be an important aetiological factor of a crippling neurological disease, the tropical ataxic neuropathy in Nigeria and Tanzania; c) organophosphate insecticides. The rarity of certain diseases in the Africans may be related specifically to the African diet, especially the high fibre and low animal fat content of many of the African diets. Examples of such diseases are atherosclerosis in the non-hypertensive non-diabetic population, cancer of the large bowel, varicose veins and perhaps multiple sclerosis.